understanding growth and puberty using the...
TRANSCRIPT
Why measure school aged
children?
• Growth as best indicator of health
• Normality by age and puberty
• Identifying disorders
• Assessing obesity
Key questions
• Is a child too short or tall for their
age – could there be a problem?
• Has puberty started and is it
progressing normally?
• Is growth normal for puberty?
• Is this child overweight or obese ?
The UK 2-18 charts will help
you answer these questions
• Developed and published by RCPCH
• Based on updated UK 1990 growth
references
• New design features that need
explaining
Working with the UK 2-18 charts
• Updating of UK90 with puberty studies
• Easier way of assessing puberty
• Help you identify growth, puberty and obesity problems more easily
• New features• Puberty Phases• BMI lookup and plotting grid • Parental height comparator • Adult height prediction
RCPCH UK 2-18 Growth chart
UK90 reference after age 4
WHO standards until age 4
Birth centiles
Predicted adult height scale
Mid parental centile scale
Use an X to mark the child’s most recent height centile in the centre line
Read off the child’s estimated adult height form right scale
80% of children will be within ±6 cm of this value
Scale also shown in feet and inches on left
Predicted Adult
Height
x
Mark mother’s height on the left hand scale and father’s height on the right scale using arrows
Draw a line between arrowheads and read off mid-parental centile where this crosses the central line
Regression adjustment means that children of very short or tall parents have mid parental centile nearer to average than expected
Mid-parental Centile
comparator
Mid parental Centile = 75th
Compare the mid-parental centile to the child’s current height centile (x)
Nine out of ten children’s height centiles are within ±two centile spaces of the
mid-parental centile.
Mid-Parental Centile
comparator
Mid parental centile = 75th
x
Interpretation of the mid-parental centile (MPHC)• Average centile for all children of these parents • Compare to child’s actual height centile • Most children are within ±two centile spaces of
the mid-parental centile• Only 1 percent more than three centile spaces
below– Most have no treatable cause for their short stature, – Investigate further if other concerns about the child’s
growth• NB a child growing abnormally may still be within
mid parental height range
Body Mass Index (BMI) lookup
• Read weight and height centiles from the growth chart.
• Plot weight centile (left axis) against the height centile (bottom axis)
• Read off the corresponding BMI centile from the slanting lines
• Record centile on grid at top of chart
• Accurate to ¼ centile space
BMI =
91st centile
BMI centile grid: plotting example
Only shows 0.4th, 2nd, 91st,98th, 99.6th
No need to plot if between 2nd and 91st
BMI Interpretation• A child whose weight is average for their height
will have a BMI between the 25th and 75th centiles
• >91st centile suggests overweight• >98th centile is very overweight (clinically
obese)• < 2nd centile may reflect undernutrition, but may
simply reflect a small frame or low muscle massBut • BMI often varies from one measurement to the
next due to measurement error• Compare BMI to weight and height centiles
using BMI plotting grid at top of chart
Pre-puberty ONLY
Puberty starting before 8 is precocious
Growth during Puberty
Plotting pubertal children on the UK 2-18 Growth charts
Most healthy children start puberty between these ages
Most healthy children complete puberty between these ages
Puberty
Lines• Puberty Lines mark
boundaries of normal pubertal development
• Shaded zone marks area where 0.4th centile varies with phase of puberty
Puberty section of New 2-18 Chart
The 3 Phases of PubertyPre-puberty(Tanner stage 1)
In Puberty (Tanner stage 2-3)
Completing Puberty(Tanner stage 4-5)
Girls If all of the following:• No signs of
nipple or breast development
• No pubic hair
If any of the following:• Any breast enlargement
so long as nipples also enlarged
• Any pubic or axillary(armpit) hair growth
If all of the following:Started periods(menarche) with breast, pubic and axillary hair development
Boys If all of the following:• High voice• No growth of
testes or penis• No pubic hair
If any of the following:• Slight voice deepening • Reddening of scrotum
with growth of the testes• Early testicular or penile
enlargement• Early pubic or axillary hair
growth
If any of the following:•Voice fully changed (broken)•Adult size of penis with pubic and axillary hair growth•Moustache and early facial hair growth
Shaded Puberty Zone• Marks area where 0.4th
centile varies with phase of puberty
• Heights in the shaded area below the 0.4th centile:– Pre-puberty: if within 2 centiles
of Mid Parental Height = within the normal range
– In or Completing puberty = below normal range
Delayed Puberty
New charts can detect delayedONSETE.G in girls puberty not started by age 13 years (14 years in boys)
andPROGRESSE.G in girls puberty not completing by age 16 years (17 years in boys)
Angela’s mother has expressed concern that she is not growing and looks pale.
She was born at term with IUGR (birth weight 2.1kg) and at school entry her height was just below 0.4th centile Now she is 11 years 4 months old with 24kg in weight and 125cm in height.
She has not yet started her periods and has no pubic or axillary hair or breast development.
• How does her height centile change once you allow for her current phase of puberty?
• Height centile <0.4th• Weight centile <0.4th• Pre puberty• >0.4th once you allow
for her current phase of puberty
Angela
Bobbi’s mother has expressed concern that she is not growing and looks pale. She was born at term (birth weight was 3.5kg) and at school entry her height was just below 0.4th centile Now she is shorter than all her peers. She is 11 years 4 months old with 21kg in weight and 125cm in height.
Bobbi has not yet started her periods but has some pubic and axillary hair and breast development.
• How does her height centile change once you allow for her current phase of puberty?
Bobbi
• Height centile <0.4th• Weight centile <0.4th• In puberty• Still <0.4th once you
allow for her current phase of puberty
CHELSEA
• Chelsea aged 14 has been measured at her GP and told that she is very overweight and needs to do something about it. Her mother thinks she is a healthy weight and does not agree that she needs to lose weight
• Her current weight is 83kg • Her current height is 166 cm
• What is her BMI• Is Mum right?
CHELSEA
• Height centile 75-91st • Weight centile >99.6th• BMI centile >99.6th• Very overweight (clinically obese)
DONNA• Donna aged 13 has been measured at her GP
and told that she is very overweight and needs to do something about it. Her mother thinks she is a healthy weight and does not agree that she needs to lose weight.
• Her current weight is 77kg • Her current height is 175 cm
• What is her BMI?• Is Mum right?
DONNA
• Height centile? >99.6th• Weight centile? >99.6th• BMI centile? 91-98th• Overweight but not obese
ElinorAged 8, parents worried that she is not growing.
Her current height is 116 cm (2nd percentile). Her father’s height is 174 cm and her mother’s height 167 cm
• What is her predicted adult height?• What is her mid parental centile? • How much does her current centile differ from
her mid parental centile? • How common is for a child to be this different
from their parents?
• Mid parental centile 50th
• Child’s centile 2nd • 3 spaces
difference• 1% or fewer
children will be this different
Elinor
FarylAged 8, parents worried that she is not growing.
Her current height is 120.5 cm (9th centile). Her father’s height is 170 cm, her mother’s 163.5cm
• What is her predicted adult height?• What is her mid parental centile?
• How much does her current centile differ from her mid parental centile?
• How common is for a child to be this different from their parents?
• Mid parental centile 25-50th
• Child’s centile 9th• 1.5 spaces
difference• More than 5%
children will be this different
Faryl
x